Eating disorders affect millions of Americans, and 50% of those individuals also struggle with drug abuse.1 Like substance use disorders, eating disorders are characterized by compulsive behaviors that make them difficult to control, which is why both types of disorders often occur together.
Drug abuse is serious and dangerous enough on its own, but when an eating disorder is also present, those risks are compounded. At this time, there is no definitive evidence that confirms whether drug use can directly cause an eating disorder, although substance abuse does cause changes in the brain that could contribute to a mental illness. Nonetheless, understanding the link between drug abuse and eating disorders may help you determine whether it’s time to seek professional treatment for one or both conditions.
Why Do Substance Addictions and Eating Disorders Co-Occur?
A substance addiction is characterized by compulsive drug use regardless of negative ramifications.2 Compulsive behaviors are actions you perform repeatedly despite the fact they may be troubling or causing problems in your life. Like addiction, many eating disorders involve unhealthy, compulsive behaviors—for example, binge eating disorder is characterized by the inability to stop eating even when you are full.
Approximately 50% of people with a drug addiction also experience a comorbid mental health condition, such as an eating disorder.3 Research suggests three reasons why substance use disorders and eating disorders often co-exist. These include:3
- Mental illness can contribute to the development of addiction: Some people with a psychiatric condition may use substances to self-medicate unwanted symptoms, creating a cycle of problematic substance use. Moreover, changes in brain chemistry due to mental illness may intensify the desired effects of drugs or alcohol, also leading to compulsive use.
- Drug abuse could contribute to the development of a mental health condition: Using drugs or alcohol can change your brain’s chemistry, which could make you susceptible to developing a mental illness—however, there is no definitive research on substance use specifically causing an eating disorder like anorexia nervosa or bulimia.
- Mental illness and substance addictions share common risk factors: Trauma and stress both increase the risk of co-occurring mental illness and addiction. Some genes may contribute to the development of both a mental health condition and drug addiction. Genes also affect how a certain drug makes you feel so some people are predisposed to liking particular substances more than others.
What are Shared Risk Factors for Drug Abuse and Eating Disorders?
Drug addictions and eating disorders share many of the same environmental and genetic risk factors, which is another reason both types of disorders may occur together.3
Shared environmental risk factors for eating disorders and drug addiction include:4
- Childhood trauma
- Childhood sexual abuse
- Poor paternal education
- Close maternal relationship
- Caregivers with addictions or eating disorders
- Maternal concern about weight loss and appearance
Some studies examining the genetic and familial link between eating disorders and drug addictions found that certain genes increase the likelihood of both conditions.4
Are Certain Substance Addictions More Likely to Co-Occur with an Eating Disorder?
Evidence suggests that some drugs are more likely to be used by those with eating disorders than others. For example, marijuana is the top drug used by people with eating disorders.1
Other drugs strongly associated with eating disorders include:1,5
- Hallucinogens
- Sedatives
- Opiates or opioids
- Cocaine or crack
Individuals with eating disorders may also misuse legal drugs, including:5
- Diet pills
- Laxatives
- Diuretics
Which Eating Disorders are Linked to Drug Abuse?
Anorexia nervosa, bulimia, and binge eating disorder are the most common eating disorders associated with drug use.5,6,7 Here’s more information about each of these eating disorders and why they tend to co-occur with substance abuse.
Anorexia Nervosa
People with this eating disorder usually have abnormally low body weight and are afraid of gaining weight, even if doing so could improve their health. They may severely restrict their food portions and exercise excessively to lose as much weight as possible and stay thin. They may also vomit after eating or use laxatives, diuretics, and enemas to quickly eliminate waste from their bodies.6
Anorexia nervosa can lead to numerous life-threatening complications, including:6,8
- Anemia
- Muscle wasting
- Brain damage
- Organ failure
- Osteoporosis
- Heart damage
- Suicide
People with anorexia nervosa may abuse drugs that suppress their appetite and increase their physical activity levels, such as caffeine pills and stimulants (e.g., cocaine, methamphetamine, and prescription stimulants like Adderall).6
Bulimia
People with bulimia eat large amounts of food (known as binging), then purge it right away to rid their bodies of the extra calories. Purging methods usually include vomiting or laxative use, though some people may use diuretics, weight-loss supplements, or enemas. People with bulimia may exercise excessively or go on a fasting diet to purge the calories instead of vomiting.7
Severe complications associated with bulimia include:7,8
- Decaying teeth
- Dehydration
- Electrolyte imbalance
- Heart attack
- Stroke
People with bulimia may use marijuana to increase their appetites and reduce anxiety associated with their eating disorder. They may also use stimulants after eating to curb their appetites and promote purging.7
Binge Eating Disorder
People with binge eating disorder eat a considerable amount of food within a short time and may feel guilty immediately afterward. These individuals often have strong urges to eat and cannot control or track the amount of food they eat while bingeing. Many people with binge eating disorder are overweight or obese, as they do not purge food after eating.8
Binge eating disorder may lead to many medical complications, such as:9
- Obesity
- Cancer
- Heart disease
- Gallbladder disease
- Diabetes
- High blood pressure
- High cholesterol
- Depression
Like with bulimia, many people with binge eating disorder may use marijuana to stimulate their appetites, or stimulants to curb eating.
Body Dysmorphic Disorder
People with body dysmorphic disorder tend to obsess about perceived flaws in their appearance that usually aren’t noticeable to others. These individuals often feel embarrassed and anxious about their appearance to the point that they avoid social situations and make numerous attempts to fix their perceived flaws without experiencing satisfaction.10
Body dysmorphic disorder can often lead to eating disorders in those who think they are too overweight or too thin. In addition to using drugs to stimulate or curb their appetites, individuals with body dysmorphia may drink alcohol or use marijuana in order to self-medicate their distress or social anxiety.10
Can Drug Abuse and Eating Disorders be Treated Together?
Substance addiction and eating disorders should be treated together. This is because both of these conditions influence one another. Without comprehensive substance abuse and eating disorder treatment, you may not address all of the underlying factors affecting both and could be at risk of relapse. For example, a person who is treated only for drug use may eventually resume drug use to reduce mental health symptoms triggered by the eating disorder.
The key to experiencing a long-lasting recovery from drug abuse and eating disorders is to find a recovery center that can treat both conditions. Some drug rehab centers do not have professionals on their staff who specialize in treating eating disorders and, therefore, may not admit patients with these disorders. At the same time, some recovery programs for eating disorders are not equipped to treat drug abuse and may exclude these patients from their programs. At this time, an estimated 16% of publicly-funded substance abuse programs also treat eating disorders.11
If you or a loved one needs treatment for drug addiction and an eating disorder, look for inpatient or residential drug rehab centers that specialize in treating co-occurring disorders and also can provide you with appropriate medical care. Drug use and eating disorders both increase the risk for medical problems, which can be properly and safely treated in an inpatient or residential treatment setting.
What are Treatments for Drug Abuse and Eating Disorders?
People with eating disorders and addictions will usually receive customized treatment at an addiction recovery center. Doctors, psychiatrists, and psychologists will often work together to create an integrated, comprehensive treatment plan based on the patient’s unique situation. Generally, drug abuse and eating disorders are treated using a combination of interventions, including:
- Drug detox
- Dietary support
- Behavioral therapy
- Counseling
- Medical management
Drug detox helps patients withdraw from any substances on which they are physically dependent. For example, a person with anorexia nervosa who became addicted to stimulants may be closely monitored by nurses and doctors in an inpatient setting as they go through withdrawal. They may also be given fluids, vitamins, and nutritional supplements intravenously to prevent complications related to both drug withdrawal and their eating disorder.
Following drug detox, patients can begin receiving all other therapies in a comfortable residential setting. Cognitive-behavioral therapy is widely used for both drug use and eating disorders, as it helps patients identify and change harmful behaviors and thoughts and find healthier coping methods. Other therapies that may be used include dialectical behavioral therapy, 12-step support groups, and relapse prevention training.
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Resources
- Root, T., Pinheiro, A.P., Thornton, L., Strober, M., Fernandez-Aranda, F., Brandt, H., Crawford, S., Fichter, M.M., Halmi, K.A., Johnson, C., Kaplan, A.S., Klump, K.L., La Via, M., Mitchell, J., Woodside, D.B., Rotondo, A., Berrettini, W.H., Kaye, W.H., Bulik, C.M. (2010). Substance use disorders in women with anorexia nervosa. International Journal of Eating Disorders, 43(1): 14–21.
- National Institute on Drug Abuse. (2018, July). The Science of Drug Use and Addiction: The Basics.
- National Institute on Drug Abuse. (2018, August). Comorbidity: Substance Use Disorders and Other Mental Illnesses DrugFacts.
- Eskander, N., Chakrapani, S., Ghani, M.R. (2020). The Risk of Substance Use Among Adolescents and Adults With Eating Disorders. Cureus Journal of Medical Science, 12(9).
- Campus Drug Prevention. (n.d.) Substance Abuse and Eating Disorders.
- U.S. Department of Health and Human Services. (2017, August). Anorexia Nervosa. Mental Health.
- U.S. Department of Health and Human Services. (2017, August). Bulimia. Mental Health.
- National Institute of Mental Health. (2016, February). Eating Disorders.
- Grant, J.E., Menard, W., Pagano, M.E., Fay, C., & Phillips, K.A. (2005). Substance use disorders in individuals with body dysmorphic disorder. Journal of Clinical Psychiatry, 66(3): 309–405.
- Substance Abuse and Mental Health Services Administration. (2011). Clients with Substance Use and Eating Disorders.